经颈静脉肝内门体分流术治疗门静脉海绵样变并发门静脉高压  

Transjugular intrahepatic portosystemic shunt for portal vein hypertension complicated from cavernous transformation of portal vein

作　　者：申权[1] 杨维竹[1] 江娜[1] 黄兢姚[1] 黄宁[1] 谢杭[1] 

机构地区：[1]福建医科大学附属协和医院介入科,福建福州350001

出　　处：《中国介入影像与治疗学》2016年第11期658-661,共4页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的探讨经颈静脉肝内门腔静脉分流术治疗合并门静脉海绵样变的门静脉高压症的疗效。方法 8例反复上消化道出血患者(均有肝硬化、门静脉高压)术前均经B超及CT等影像学证实伴有门静脉海绵样变,门静脉主干及左右支有完全或部分闭塞,对其行TIPS治疗,并评价疗效。结果对7例患者均成功施行TIPS术,1例失败,6例为先经皮穿刺右肝门静脉分支,建立经门静脉右支至主干通道,并行球囊扩张成形治疗。其中4例经常规TIPS途径由肝右静脉穿刺门静脉右支建立门腔静脉分流道,2例由门静脉右支穿刺右肝静脉建立门腔静脉分流道。1例穿刺门静脉右支失败,改由常规TIPS途径穿刺门静脉左支建立门腔静脉分流道。门静脉压力由术前的(33.72±8.35)mmHg降低至术后的(21.43±7.64)mmHg;1例在术后6个月发现分流道狭窄,再次植入支架后恢复通畅。1例术后5个月再发黑便,复查提示分流道堵塞,并门静脉广泛血栓形成,放弃进一步治疗。另5例在12个月随访中分流道通畅,未再发消化道出血。结论 TIPS是治疗伴门静脉海绵样变的门静脉高压症的安全、有效的方法。Objective To investigate the therapeutic effect of transjugular intrahepatic portosystemic shunt （TIPS） on portal vein hypertension complicated with cavernous transformation of portal vein （CTPV）. Methods Eight patients with recurrent upper gastrointestinal bleeding （all had liver cirrhosis, portal hypertension） were diagnosed with CTPV by B ultrasonography or contrast-enhanced CT preoperatively. Total or partial occlusion of the main and left or right branches of the portal vein were observed. All patients were underwent TIPS, and the efficiency was evaluated. Results TIPS was successfully performed in 7 cases, 1 case failure. Six cases were percutaneous puncture branch of right portal vein, and the passageway of the portal vein right branch to the main portal vein were established, than the parallel balloon expansion therapy was performed. The portosystemic shuntway was established in 4 cases by conventional TIPS method, the portosystemic shuntway was established in 2 patients by puncture from right branch of portal vein to right hepatic vein. One case failed in puncture the right branch of portal vein, and portosystemic shuntway by conventional TIPS puncture left branch of portal vein was established. Portal pressure was reduced from preoperative （33.72±8.35）mmHg to postoperative （21.43±7.64）mmHg. One case shunt stenosis were found in 6 months after operation, and patency was restored after implanting stents again; 1 case melena again 5 months after operation, shuntway blockage and portal vein thrombus extensive formation were found, and the patient gave up further treatment. In the other 5 cases, the shuntway kept patency during the follow-up of 12 months, and no recurrent hemorrhage of digestive tract occured. Conclusion TIPS is a safe and effective way to treat portal vein hypertension complicated with CTPV.

关 键 词：经颈静脉肝内门体静脉分流 门静脉海绵样变 门静脉高压 

分 类 号：R57[医药卫生—消化系统]